A doctors’ group on Thursday suggested that sex may be safe for most heart patients. The American Heart Association added that having sex only slightly raises the chance for a heart attack. And that’s true for people with and without heart disease. Despite the higher risk for a heart patient to have a second attack, there’s no evidence that they have more sex-related heart attacks than people without cardiac disease. The updated advice was released online Thursday in the heart association journal, Circulation.
Dr. Glenn Levine, lead author of a report detailing the recommendations and a professor of medicine at Baylor College of Medicine in Houston said many heart patients don’t think twice about climbing stairs, yet many worry that sexual activity will cause another heart attack, or even sudden death. He added that few doctors speak of sex with heart patients. The new guidance is designed to fill that gap.
Levine’s research group reviewed more than 100 studies to determine the risks. In autopsy reports of 5,559 cases of sudden death, 0.6 percent occurred during sexual intercourse, they found. Of those who died, 82 percent to 93 percent were men and 75 percent were having extramarital sex, in most cases with a younger partner and after excessive food and alcohol consumption, the report said.
The doctors’ group offers advice for heart patients based on scientific research involving sometimes provocative sex-related topics. Some of these include higher risk of sudden death related to sex in married men having affairs, often with younger women in unfamiliar settings. Those circumstances can add to stress that may increase the risks, evidence from a handful of studies suggests. Sex may be OK as soon as one week after a relatively mild heart attack, if patients can walk up a few flights of stairs without discomfort. Viagra and other drugs for erectile dysfunction are generally safe for men with stable heart disease.
“The risk of having a heart attack during sexual activity is two to three times higher than when not having sexual activity. However, this increased risk of heart attack during sexual activity represents only a very small part of a person’s overall risk of having a heart attack, and sexual activity is the cause of less than 1 percent of all heart attacks,” Levine said.
Among heart attack survivors, average risks for another heart attack or sudden death are about 10 in 1 million per hour of sexual activity; having sex increases that to about 20 to 30 in 1 million per hour, the new report says. People without heart disease face lower overall risks for a heart attack, but similar risks for a sex-related attack.
The new guidelines address all forms of heart disease, including coronary artery disease, heart failure, heart-rhythm disorders (arrhythmias), and valve problems. If a heart patient's condition is at all uncertain after an initial consultation with a doctor, the guidelines recommend that he or she undergo an exercise stress test, which involves monitoring heart activity and breathing while walking (or running) on a treadmill.
Even after being cleared for sex, patients may want to take some basic precautions. According to the guidelines, doctors should advise their patients to avoid heavy meals and alcohol before sex, use a position that allows for free breathing, and avoid “unfamiliar surroundings and partners.”
In addition, patients may need to temporarily lower their expectations. “The achievement of orgasm may require a greater degree of exertion and may not be a realistic initial goal in some patients,” Levine and his colleagues write.
Dr. Keith Churchwell, chief medical officer of Vanderbilt University’s Heart and Vascular Institute, said the guidance is important for patients. Ohio State University heart specialist Martha Gulati praised the recommendations for emphasizing that sexual counseling is important not just for patients but also their partners, who she says are often just as nervous about resuming sexual activity. Chicago cardiologist Dan Fintel, a professor of medicine at Northwestern University, said he routinely gives heart patients a sex talk on their last day in the hospital, knowing that it’s likely on their minds. “Resuming sexual activity is safe and emotionally part of the healing process, with a few caveats,” he tells patients.
Stephen Kopecky, a cardiologist at the Mayo Clinic, in Rochester, Minnesota, says many patients who have a heart attack or undergo bypass surgery become depressed, which can reduce libido and affect sexual function. To make matters worse, he says, avoiding sex can in turn worsen depression. “That's why it's so important for us to talk to patients about this, and tell them this is not the end of [their] sex life,” says Kopecky, who has studied sexual activity in heart patients but did not participate in writing the new guidelines.
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